Columbia University Health Services


Anonymous Report Form

General Information
Was the victim referred to support services?*
If victim was referred, to which department?
Check all that apply.*
When Did Incident Occur?
Incident Location*
Type of Offense*
Was this a hate crime?*

A hate crime is one in which the victim was intentionally selected because of the perpetrator's bias, with categories of bias including Race, Gender, Religion, Sexual Orientation, Ethnicity, National Origin, and Disability.)

If all of the above questions are answered, you have complied with the Clery Act requirements. Thank you for completing this form.

Please answer the following questions to the best of your knowledge

Was the use of alcohol and/or
drugs used to incapacitate the victim?
Victim Information
Victim's College
Offender Information
Offender's College
Please Describe the Incident
The letter H
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Important Phone Numbers

General Information 212 854 2284
After-hours urgent health concerns 212 854 9797
CAVA (Ambulance) 212 854 5555
Rape Crisis/Anti-Violence Support Center 212 854 WALK
Uptown Campus Public Safety
 - On-Campus 7-7979
 - Off-Campus 212-305-8100